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Scarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019.
Health indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs.
Between 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion).
The results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.
Despite unprecedented progress in developing COVID-19 vaccines, global vaccination levels needed to reach herd immunity remain a distant target, while new variants keep emerging. Obtaining near universal vaccine uptake relies on understanding and addressing vaccine resistance. Simple questions about vaccine acceptance however ignore that the vaccines being offered vary across countries and even population subgroups, and differ in terms of efficacy and side effects. By using advanced discrete choice models estimated on stated choice data collected in 18 countries/territories across six continents, we show a substantial influence of vaccine characteristics. Uptake increases if more efficacious vaccines (95% vs 60%) are offered (mean across study areas = 3.9%, range of 0.6%–8.1%) or if vaccines offer at least 12 months of protection (mean across study areas = 2.4%, range of 0.2%–5.8%), while an increase in severe side effects (from 0.001% to 0.01%) leads to reduced uptake (mean = −1.3%, range of −0.2% to −3.9%). Additionally, a large share of individuals (mean = 55.2%, range of 28%–75.8%) would delay vaccination by 3 months to obtain a more efficacious (95% vs 60%) vaccine, where this increases further if the low efficacy vaccine has a higher risk (0.01% instead of 0.001%) of severe side effects (mean = 65.9%, range of 41.4%–86.5%). Our work highlights that careful consideration of which vaccines to offer can be beneficial. In support of this, we provide an interactive tool to predict uptake in a country as a function of the vaccines being deployed, and also depending on the levels of infectiousness and severity of circulating variants of COVID-19.
Le changement climatique, la perte de la biodiversité et l’altération globale de l’environnement détériorent la santé des populations. Plus particulièrement, l’augmentation des périodes marquées par des températures élevées et leur persistance pourraient constituer un risque majeur pour une large part de la population et limiter drastiquement l’activité humaine. Pourtant, les vagues de chaleur sont sous-représentées dans les analyses des événements météorologiques extrêmes, en particulier dans les évaluations économiques. Ce manque d’études, associé à la faible perception par la population du risque lié à la chaleur, limite la mise en place de mesures d’adaptation, alors que les effets des canicules sont en grande partie évitables. Cet article présente l’évolution de l’impact économique global des effets sanitaires des vagues de chaleur observées en France entre 1974 et 2020.
Redistributive justice is based on the premise that it is unfair for people to be better or worse off relative to others simply because of their fortune or misfortune. It assumes equal opportunities arising from four factors: social circumstances, effort, option luck and brute luck. This paper seeks to investigate how differences in perceived brute luck influence individual preferences for redistribution in favour of two public policies: “health intervention” and “environmental actions”. These policies are viewed somewhat differently: the environment is considered a pure “public good” and health, more as a “private good” with a strong public good element. Consequently, potential self-serving biases inherent in the preferences for redistributive policies are expected to differ, more likely favouring health than the environment. The perceived degree of brute luck may capture such a difference—those perceiving themselves as luckiest should be less amenable to redistribution in favour of health than the unluckiest. Data from the three waves (2000, 2006 and 2008) of a French population survey are used to examine this self-serving bias. A Generalised Ordered Logit (GOL) model is found to be statistically more relevant compared to other logistic regression models (multinomial and ordered). We find that a perceived low degree of brute luck is significantly associated with a decreased preference of redistributive environmental policies but the reverse is true for redistributive health policies, i.e., association with an increased preference. Assuming that all inequalities due to differing luck are unjust, this empirical validation gives redistributive justice grounds for equalisation policies regarding health.
Developing countries face major challenges in implementing universal health coverage (UHC): a widespread informal sector, general discontent with rising economic insecurity and inequality and the rollback of state and public welfare. Under such conditions, estimating the demand for a health insurance scheme (HIS) on voluntary basis can be of interest to accelerate the progress of UHC-oriented reforms. However, a major challenge that needs to be addressed in such context is related to protest attitudes that may reflect, inter alia, a null valuation of the expected utility or unexpressed demand.
We propose to tackle this by applying a contingent valuation survey to a non-healthcare-covered Tunisian sample vis-à-vis joining and paying for a formal HIS. Our design pays particular attention to identifying the nature of the willingness-to-pay (WTP) values obtained, distinguishing genuine null values from protest values. To correct for potential selection issues arising from protest answers, we estimate an ordered-Probit-selection model and compare it with the standard Tobit and Heckman sample selection models.
Our results support the presence of self-selection and, by predicting protesters' WTP, allow the “true” sample mean WTP to be computed. This appears to be about 14% higher than the elicited mean WTP.
The WTP of the poorest non-covered respondents represents about one and a half times the current contributions of the poorest formal sector enrolees, suggesting that voluntary participation in the formal HIS is feasible.
Cet article propose une approche intégrant le temps de latence dans le processus d’évaluation de la mortalité de long terme et dans sa valorisation économique, suite à un choc transitoire. Il l’applique aux conséquences des restrictions d’activité en lien avec la Covid‑19 au printemps 2020 sur la pollution de l’air ambiant en France. Ces conséquences sont évaluées en termes d’années de vie gagnées (AVG) ainsi qu’en termes monétaires pour deux indicateurs de pollution de l’air. Cette approche est comparée à une estimation standard par différence. Elle conduit à des résultats inférieurs d’un facteur 3.7 à 5.5 pour les AVG et, du fait de l’influence additionnelle de l’actualisation, à une valorisation économique inférieure d’un facteur 4.7 à 6.9. Ces résultats indiquent qu’une évaluation adaptée des bénéfices sanitaires de long terme, puis leur traduction en termes monétaires, est essentielle pour comparer les conséquences à long terme de politiques ou de chocs exogènes transitoires.
We provide an estimate of the environmental impact of the recruitment system in the economics profession, known as the “international job market for economists”. Each year, most graduating PhDs seeking jobs in academia, government, or companies participate in this job market. The market follows a standardized process, where candidates are pre-screened in a short interview which takes place at an annual meeting in Europe or in the United States. Most interviews are arranged via a non-profit online platform, econjobmarket.org, which kindly agreed to share its anonymized data with us. Using this dataset, we estimate the individual environmental impact of 1057 candidates and one hundred recruitment committees who attended the EEA and AEA meetings in December 2019 and January 2020. We calculate that this pre-screening system generated the equivalent of about 4800 tons of avoidable CO2-eq and a comprehensive economic cost over €4.4 million. We contrast this overall assessment against three counterfactual scenarios: an alternative in-person system, a hybrid system (where videoconference is used for some candidates) and a fully online system (as it happened in 2020–21 due to the COVID-19 pandemic). Overall, the study can offer useful information to shape future recruitment standards in a more sustainable way.
Reducing the mortality burden associated with urban air pollution constitutes a public health priority, and evidence of unequal exposure and susceptibility across population subgroups is growing. Many European countries have implemented low emission zones (LEZs) in densely populated city centers. Although LEZs decrease air pollution exposure and health impacts, evidence is lacking on their impact across neighborhoods and socio-economic groups.
The aim of this study was to evaluate the most equitable approach to implementing the second phase of the LEZ in Paris, France. We also present a literature review of the studies evaluating the benefits associated with LEZs in Europe.
A health impact assessment (HIA) was conducted to quantify changes in air pollution exposure and expected health benefits by socioeconomic group and neighborhood related to four hypothetical scenarios for the second phase of the LEZ based on French Deprivation Index scores. The study focused on NO2 and PM2.5 as air pollutants and evaluated the impact of the LEZ on the inequitable burden of childhood asthma and all-cause premature adult mortality. We also conducted an economic evaluation associated with the LEZ benefits on prevented deaths and asthma cases.
The scenario with the largest LEZ perimeter and the most stringent vehicle standards prevented the highest number of cases and produced the most equitable distribution of health benefits, especially childhood asthma. It is expected that 810 deaths and 3200 cases of asthma could be prevented from the LEZ extension in this scenario. These results were distributed heterogeneously across three socioeconomic (SES) groups, most noticeably with asthma cases as 230, 180, and 210 cases were avoided per 100,000 inhabitants in high, medium, and low SES groups, respectively. We found substantial economic benefits associated with LEZ, with estimates ranging from €0.76 billion to €2.36 billion for prevented deaths. The benefits associated with asthma reduction ranged from €2.3 million to €8.3 million.
Conducting HIAs with a focus on equity will further inform policy makers of the impact of LEZ models on air pollution, health, and environmental justice. Developing these systematic methods and applying them to future LEZs and other air pollution policies will increase their effectiveness to reduce the burden of ambient air pollution on society and the environment.
We propose a structural econometric model that incorporates altruism towards other household members into the willingness to pay for a public good. The model distinguishes preferences for public good improvements for oneself from preferences for improvements for other household members. We test for three different types of altruism - ‘pure self-interest’, ‘pure altruism’ and ‘public-good-focused non-pure altruism’. Using French contingent valuation data regarding air quality improvements, we find positive and significant degrees of concern for children under the age of 18, which are explained by determinants related to health and subjective air quality assessment. All other forms of pure or air-quality-focused altruism within the family are insignificant, including for children over 18, siblings, spouses, and parents. This result suggests that benefit estimates that do not consider altruism could undervalue improvements in air quality in France.
In September 2021, the World Health Organization decided to implement stronger air quality guidelines for protecting health, based on the last decade of research. Ambient air pollution (AAP) was already the first environmental risk to health in terms of number of premature deaths, and this decision suggests that the risk was seriously underestimated. This chapter covers the relationship between AAP and health from an economic perspective. The first part presents the major regulated air pollutants and their related health effects, the way population exposure is measured, and the individual vulnerability and susceptibility to AAP-related effects. Then, the main approaches that estimate the relationships between health effects and air pollutants are covered: pure observational and interventional/quasi-experimental studies. Up-to-date reviews of the most robust relationships, and of the main findings of interventional/causal inference methods, are detailed. Next, impact assessments studies are tackled and some recent global assessments of health impacts due to AAP are presented. Once calculated, the health impacts can be expressed in monetary terms to enter the decision-making process. The relevant approaches for valuing market and nonmarket health impacts – market prices, revealed and stated preferences – are critically outlined, and their adequation with the AAP context examined. Finally, the economic health-related impacts of AAP are presented and discussed, with specific sections devoted to the necessity of an interdisciplinary approach and inequity-related issues at national and international levels. This chapter concludes with a widening of the perspective that tackles interactions between AAP on the one hand and climate change and indoor pollution on the other hand.
This paper investigates how affective forecasting errors (A.F.E.s), the difference between anticipated emotion and the emotion actually experienced, may induce changes in preferences on time, risk and occupation after combat. Building on psychological theories incorporating the role of emotion in decision-making, we designed a before-and-after-mission survey for Danish soldiers deployed to Afghanistan in 2011. Our hypothesis of an effect from A.F.E.s is tested by controlling for other mechanisms that may also change preferences: immediate emotion, trauma effect – proxied by post-traumatic stress disorder (P.T.S.D.) – and changes in wealth and risk perception. At the aggregate level, results show stable preferences before and after mission. We find positive A.F.E.s for all three emotions studied (fear, anxiety and excitement), with anticipated emotions stronger than those actually experienced. We provide evidence that positive A.F.E.s regarding fear significantly increase risk tolerance and impatience, while positive A.F.E.s regarding excitement strengthen the will to stay in the military. Trauma has no impact on these preferences.
Revealed and stated preference techniques are widely used to assess willingness to pay (WTP) for non-market goods as input to public and private decision-making. However, individuals first have to satisfy subsistence needs through market good consumption, which affects their ability to pay. We provide a methodological framework and derive a simple ex post adjustment factor to account for this effect. We quantify its impacts on the WTP for non-market goods and the ranking of projects theoretically, numerically and empirically. This confirms that non-adjusted WTP tends to be plutocratic: the views of the richest – whatever they are – are more likely to impact decision-making, potentially leading to ranking reversal between projects. We also suggest that the subsistence needs-based adjustment factor we propose has a role to play in value transfer procedures. The overall goal is a better representation of the entire population’s preferences with regard to non-market goods.